Welcome to the ESPNIC Xperience Programme Scheduling

Background and Aims

Approximately 2 out of 1000 children require critical care support, but little is known about the impact of critical illness into school performance. While major post-intensive care sequelae affect up to one in three adult survivors of critical illness, similar data for critically ill children are lacking.

We aimed to determine primary school educational outcomes in children who required admission to PICU during childhood.

Methods

Multicentre population-based linkage study. Children <5 years old admitted to PICU in Queensland, Australia, between 1997 and 2016 were eligible if they had survived until the age of NAPLAN testing. Using the National Assessment Program – Literacy and Numeracy (NAPLAN) database, the primary outcome was defined as educational achievement below the National Minimum Standard (NMS) in year 3 of primary school.

Results

Primary school data were available for 5,017 PICU survivors (median age 8.0 months at first PICU admission). PICU survivors scored significantly lower than controls across each domain (p<0.001). 14.03% of PICU survivors did not meet the NMS, compared to 8.96% of matched controls (p<0.001). In multivariate analyses, socioeconomic status (OR 2.14; 95%-CI 1.67-2.74), logit of Pediatric Index of Mortality-2 score (1.11; 1.03-1.19), and presence of a syndrome (11.58; 8.87-15.11) were some of the key predictors of not meeting the NMS.

Conclusions

In this study of childhood PICU survivors, 14.03% did not meet national minimum standards in the standardized primary school assessment. Socioeconomic status, underlying diseases, and severity on presentation allow risk-stratification to identify children most likely to benefit from individual follow-up and support.

Background and Aims

Respiratory insufficiency due to bronchiolitis belongs to one of the most frequent indications for admission to the Pediatric Intensive Care Unit (PICU). Earlier research has shown that these children are at risk for decreased neurocognitive functioning. Neurocognitive impairments in childhood are known to interfere with development in crucial outcome domains, such as behavioral and academic functioning. To the best of our knowledge, this observational study is the first to investigate the association between severe bronchiolitis and the long-term behavioral outcomes.

Methods

Children aged 6-12 years admitted to our PICU (age <10 months) for respiratory insufficiency due to bronchiolitis were included. Healthy peers, matched with patients on age, sex and socioeconomic status, served as controls. Behavioral outcomes were assessed using parental and teacher ratings (i.e. CBCL, SWAN and TRF) of internalizing, externalizing and attention problems as well as academic achievement.

Results

A total of 65 PICU patients (age: M=8.14 years, SD=1.19) and 76 controls were included. Behavioral outcomes regarding internalizing, externalizing and attention problems were not significantly different between the two groups. There were more teacher-reported problems on academic achievement (mean (SE) difference -4.99 (1.80), p<.01) and learning (mean (SE) difference -4.66 (1.39), p<.01) in the PICU group as compared to the control group.

Conclusions

We found no evidence for long-term behavioral sequelae in children with a history of PICU admission for respiratory insufficiency due to bronchiolitis, while teachers did report poorer academic achievement and more learning problems. These findings warrant further research into academic outcome of children admitted to the PICU for bronchiolitis.

Background and Aims

Neurodevelopment of preterm infants is widely assessed using Bayley Scales of Infant and Toddler Development-3^rd Edition (Bayley-III). However, the changes of Bayley-III scores from 1 to 2 years are sparsely reported.

To describe the correlations of Bayley-III scores from 12 to 24 months corrected age (CA), and to assess the changes of neurodevelopmental classifications between these two ages.

Methods

Design and setting

A cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children’s hospital in Vietnam in the year 2013-2014.

Participants

Infants born at < 37 weeks of gestational age.

Main outcomes

Cognitive, language, and motor Bayley-III scores at 12 and 24 months CA.

Results

Of 294 preterm infants, 169/243 (70%) survivors were assessed twice at 12 and 24 months. The Bayley-III scores between the two ages showed weak to moderate correlations with the highest for motor (r = 0.48) and the lowest for cognition (r = 0.28). From 12 to 24 months, while language and motor scores showed significant improvements (8.0, 95% CI: 6.0 to 10.1; and 4.7, 95% CI: 3.1 to 6.3), cognitive scores showed a noticeable decrease (-14.5, 95% CI: -16.2 to -12.8). More than a third (38%) were reclassified into cognitive impairment at 24 months despite being normal at 12 months.

Conclusions

In conclusion, Bayley-III scores between 12 and 24 months CA among preterm infants showed weak to moderate correlations with improvements in language and motor. These findings suggest a longer follow-up for preterm infants to at least 24 months.

Background and Aims

In response to the COVID-19 pandemic, hospitals visiting policies changed, mainly due to concerns relating to visitor-driven viral transmission. Family visitation policies were especially restricted in adult and paediatric critical care areas.

The aim of this study was to evaluate visiting policies of PICUs around the world; and how pandemic affected these policies.

Methods

A web-based survey was designed and disseminated through social networks, email or direct messages.

Results

241 answers were received. From these, 23 were excluded (11 missing location, 12 duplications), totalling 218 answers. Europe accounted for 35% of responses (n=77); South America, 22,4% (n=49); North America, 19% (n=41); Asia, 16,5% (n=36); Central America, 2,7% (n=6), Oceania and Africa, 2,2% each (n=5 each). Pre-pandemic, reported admission policies already varied between continents. Family time schedules remained similar to the pre-pandemic period in half of European, Central and South American units. By contrast, they changed in 60% of Asian, African, North American and Oceanian units. Entrance to PICUs was granted to patients and caregivers that tested negative for SARSCOV-2 only in part of responding PICUs. Predictably, the implementation of gowning requirements and hand hygiene upon PICU admission intensified during the pandemic.

Conclusions

Visiting policies changes were observed in most PICUs worldwide during the COVID-19 pandemic, visitation was even prohibited altogether in some units. These changes can decrease parental participation and a shared decision-making process with healthcare providers, in turn this is likely to impact negatively on both children and parental well-being.

Background and Aims

To identify and establish research priorities for paediatric intensive care unit (PICU) nursing across Asia countries.

Methods

A three-round e-Delphi technique was used between July 2020 and March 2021. Questionnaires were translated into six languages. Participants were PICU clinical nurses, managers and educators from Asian PICUs. In round 1, content analysis was used to analyse qualitative responses to generate domains and statements. In round 2 and 3, the statements were ranked using a 6-point scale ranging from one to six (not important to extremely important). Mean scores from round 2 were included for round 3.

Results

Round 1 started with 146 participants across eight Asian countries (21 PICUs) with round 3 completed by 95 (65%) participants. Round 1 generated 50 research-related statements categorised in 7 domains. In round 3, the overall mean scores of the domains resulted were ranked from highest to lowest priority: 1) End-of-life care, 2) professional issues, 3) pain, sedation and delirium, 4) clinical nursing practices, 5) child and family centered care, 6) safety and quality and 7) rehabilitation and follow-up. The 10 highest ranked statements received a mean scores of >5.4 and were related to recognising early deterioration, supportive care, nurse-led interventions, medication safety, job satisfaction, end-of-life care, and collaboration between families and professionals.

Conclusions

The results inform a roadmap of a paediatric critical care nursing research priorities in Asia in collaboration with Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN).